Convenience often leads parents to retail clinics for a child's care, even when their pediatrician's office is open, a survey of almost 1,500 parents showed.

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An increasing number of parents are taking their children to retail clinics even though they have an established relationship with a pediatrician.

The primary reason given is that of convenient hours and the lack of an appointment at the pediatrician's office.

Most commonly, visits were for acute upper respiratory tract illnesses and for physicals.

Convenience often leads parents to retail clinics for a child's care, even when their pediatrician's office is open, a survey of almost 1,500 parents showed.

Almost one-fourth of respondents reported taking their children to retail clinics and three-fourths of those (74%) said they'd initially considered going to their regular pediatricians.

Parents who opted for a retail clinic usually did so because it had more convenient hours (36.6%), they had no appointment with their regular pediatrician (15.4%), or they were reluctant to bother the family pediatrician after hours (13%), Jane M. Garbutt, MB ChB, of Washington University in St. Louis and co-authors reported online in JAMA Pediatrics.

"Many parents with established relationships with a pediatrician use retail clinics for themselves and for their children, with some repeatedly choosing the retail clinic instead of an office visit," they concluded. "These parents believe retail clinics provide better access to timely care at hours convenient to the family's schedule.

"Pediatricians can address concerns about quality of care, duplication of services, and disrupted care coordination by working to optimize communication with the retail clinics themselves, as well as with their parents, regarding appropriate management of acute minor illnesses and the role of retail clinics. They also will need to directly address parents' need for convenient access to care."

Retail clinics have proliferated in response to parents' demand for convenient healthcare access for minor illnesses. Currently estimated at 600 nationwide, the clinics often are located within high-traffic retail stores, such as large drugstore chains. Nonpediatric nurse practitioners and physician assistants staff most of the retail clinics.

Reduced overhead costs have resulted in prices that are lower than at an emergency department, an urgent-care clinic, or a pediatrician's office, according to the authors. Many insurers, including Medicaid, cover services provided by retail clinics in full or in part.

Despite the clinics' popularity with parents and payers, professional organizations (including the American Academy of Pediatrics and the American Academy of Family Physicians) have expressed concern about the quality of care provided at the clinics. Some recent studies have suggested that the clinics may adversely affect continuity of care for families with children.

The medical literature has little information on use of retail clinics. Most studies have relied on administrative databases, and few have focused specifically on pediatric care, the authors continued.

To examine retail clinics from the parental perspective, Garbutt and colleagues conducted a cross-sectional study involving 19 pediatric practices in the Midwest. Parents who brought their children to the participating practices were invited to complete a survey about their experiences with pediatric care at retail clinics.

The investigators received completed surveys from 1,484 parents. The results showed that 37.4% of respondents had sought care for themselves at retail clinics, and 23.2% of the parents had patronized retail clinics for pediatric care.

Those who had taken their children to retail clinics were significantly more likely to report having used such facilities for their own care (OR 7.79, 95% CI 5.13-11.84), to have more than one child (OR 2.16, 95% CI 1.55-3.02), and to be older (OR 1.05, 95% CI 1.03-1.08).

The data showed that 47% of all visits to retail clinics occurred between 8 a.m. and 4 p.m. on weekdays or between 8 a.m. and noon on weekends. Ailments most likely to generate a visit to a retail clinic were sore throat (34.3%), ear infection (26.2%), colds or flu (19.2%), and physicals for camp or school (13.1%).

Garbutt and colleagues reported that 7.3% of parents said that personnel at the retail clinics indicated that the family pediatrician would be notified of the visit. The investigators found that parents notified their pediatricians of visits to retail clinics in 41.8% of cases.

In 40% of cases, parents had follow-up contact with the retail clinics, primarily by telephone (34.9%) but also by email (2.5%), and other means of communication (2.2%). In 43.2% of cases, parents said they were advised by retail clinic personnel to seek follow-up care with their regular pediatricians.

A majority of the parents (61.7%) were satisfied with the care their children received at retail clinics, and 32.8% said they were very satisfied with the care. More than half of the parents (53.4%) said they would use retail clinics again for pediatric care, and 38.9% said they might use the clinics in the future.

Although the survey paints a favorable picture of retail clinics, considerations other than convenience should figure into parents' decision making, said Andrew Hertz, MD, of University Hospitals Case Medical Center in Cleveland.

"We all know that we believe in the medical home, and that the care you receive in the retail clinics is fragmented, it's of lower quality, people don't know your entire history," Hertz told MedPage Today.

"It's something that [pediatricians] have to work hard, as a group collectively, to try to educate the public that they're not getting the same quality care from the retail clinic as from their primary care provider."

The study was supported by the National Institutes of Health.

The authors reported no relevant disclosures.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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